Evidence-based tailored nutrition educational intervention improves adherence to dietary guidelines, anthropometric measures and serum metabolic biomarkers in early-stage breast cancer patients: A prospective interventional study

Purpose: The impact of the adherence to dietary guidelines of early-stage breast cancer (EBC) patients on body composition changes during treatment is not entirely defined. This study aimed to evaluate the role of an evidence-based nutrition educational intervention, according to adherence to dietary guidelines, in EBC patients. Methods: This prospective study included EBC patients, candidates for neoadjuvant/adjuvant therapy. Patients received an evidence-based tailored nutrition educational intervention. The adherence to dietary guidelines, anthropometric and dietary assessments, and blood glucose and lipid profile tests were evaluated at baseline and after a 12-months nutritional intervention. Results: Two hundred and forty-three patients were enrolled. At baseline, 38.3% and 23.9% of patients were overweight and obese, weight gain ≥5% (compared to 6-months before enrollment) and central obesity were observed in 47.3% and 52.7% of patients, respectively. Adherence to dietary guidelines was low (median Med-Diet score: 6 [IQR 4-8]). After the nutritional intervention (median follow-up: 22 months [range 12-45]), adherence to dietary guidelines significantly increased (median Med-Diet score: 12 [IQR 8-13]), p < 0.0001). High adherence to dietary guidelines (defines as Med-Diet score ≥10) significantly correlated with: 1) overall weight loss ≥5% (21.8% vs. 2.5%, p = 0.003); 2) median BMI drop (from 25.6 kg/m2 to 24.4 kg/m2, p = 0.003); 3) lower prevalence of central obesity (38.2% vs. 7.2%, p = 0.01); 4) improvement in blood glucose levels and lipid profile. Conclusion: This study suggests that an evidence-based tailored nutrition educational intervention during treatment for EBC significantly increases overall adherence to dietary guidelines, and it improves both anthropometric measures and serum metabolic biomarkers in patients with high adherence

A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Reducing Mortality

The authors aimed to identify interventions documented by randomized controlled trials (RCTs) that reduce mortality in adult critically ill and perioperative patients, followed by a survey of clinicians’ opinions and routine practices to understand the clinicians’ response to such evidence. The authors performed a comprehensive literature review to identify all topics reported to reduce mortality in perioperative and critical care settings according to at least 2 RCTs or to a multicenter RCT or to a single-center RCT plus guidelines. The authors generated position statements that were voted on online by physicians worldwide for agreement, use, and willingness to include in international guidelines. From 262 RCT manuscripts reporting mortality differences in the perioperative and critically ill settings, the authors selected 27 drugs, techniques, and strategies (66 RCTs, most frequently published by the New England Journal of Medicine [13 papers], Lancet [7], and Journal of the American Medical Association [5]) with an agreement ≥67% from over 250 physicians (46 countries). Noninvasive ventilation was the intervention supported by the largest number of RCTs (n = 13). The concordance between agreement and use (a positive answer both to “do you agree” and “do you use”) showed differences between Western and other countries and between anesthesiologists and intensive care unit physicians. The authors identified 27 clinical interventions with randomized evidence of survival benefit and strong clinician support in support of their potential life-saving properties in perioperative and critically ill patients with noninvasive ventilation having the highest level of support. However, clinician views appear affected by specialty and geographical location

Country-level gender inequality is associated with structural differences in the brains of women and men

男女間の不平等と脳の性差 --男女間の不平等は脳構造の性差と関連する--. 京都大学プレスリリース. 2023-05-10.Gender inequality across the world has been associated with a higher risk to mental health problems and lower academic achievement in women compared to men. We also know that the brain is shaped by nurturing and adverse socio-environmental experiences. Therefore, unequal exposure to harsher conditions for women compared to men in gender-unequal countries might be reflected in differences in their brain structure, and this could be the neural mechanism partly explaining women’s worse outcomes in gender-unequal countries. We examined this through a random-effects meta-analysis on cortical thickness and surface area differences between adult healthy men and women, including a meta-regression in which country-level gender inequality acted as an explanatory variable for the observed differences. A total of 139 samples from 29 different countries, totaling 7, 876 MRI scans, were included. Thickness of the right hemisphere, and particularly the right caudal anterior cingulate, right medial orbitofrontal, and left lateral occipital cortex, presented no differences or even thicker regional cortices in women compared to men in gender-equal countries, reversing to thinner cortices in countries with greater gender inequality. These results point to the potentially hazardous effect of gender inequality on women’s brains and provide initial evidence for neuroscience-informed policies for gender equality

Country-level gender inequality is associated with structural differences in the brains of women and men

Gender inequality across the world has been associated with a higher risk to mental health problems and lower academic achievement in women compared to men. We also know that the brain is shaped by nurturing and adverse socio-environmental experiences. Therefore, unequal exposure to harsher conditions for women compared to men in gender-unequal countries might be reflected in differences in their brain structure, and this could be the neural mechanism partly explaining women's worse outcomes in gender-unequal countries. We examined this through a random-effects meta-analysis on cortical thickness and surface area differences between adult healthy men and women, including a meta-regression in which country-level gender inequality acted as an explanatory variable for the observed differences. A total of 139 samples from 29 different countries, totaling 7,876 MRI scans, were included. Thickness of the right hemisphere, and particularly the right caudal anterior cingulate, right medial orbitofrontal, and left lateral occipital cortex, presented no differences or even thicker regional cortices in women compared to men in gender-equal countries, reversing to thinner cortices in countries with greater gender inequality. These results point to the potentially hazardous effect of gender inequality on women's brains and provide initial evidence for neuroscience-informed policies for gender equality

Dissociation between arithmetic relatedness and distance effects is modulated by task properties: an ERP study comparing explicit vs. implicit arithmetic processing.

Event-related potential (ERP) studies have detected several characteristic consecutive amplitude modulations in both implicit and explicit mental arithmetic tasks. Implicit tasks typically focused on the arithmetic relatedness effect (in which performance is affected by semantic associations between numbers) while explicit tasks focused on the distance effect (in which performance is affected by the numerical difference of to-be-compared numbers). Both task types elicit morphologically similar ERP waves which were explained in functionally similar terms. However, to date, the relationship between these tasks has not been investigated explicitly and systematically. In order to fill this gap, here we examined whether ERP effects and their underlying cognitive processes in implicit and explicit mental arithmetic tasks differ from each other. The same group of participants performed both an implicit number-matching task (in which arithmetic knowledge is task-irrelevant) and an explicit arithmetic-verification task (in which arithmetic knowledge is task-relevant). 129-channel ERP data differed substantially between tasks. In the number-matching task, the arithmetic relatedness effect appeared as a negativity over left-frontal electrodes whereas the distance effect was more prominent over right centro-parietal electrodes. In the verification task, all probe types elicited similar N2b waves over right fronto-central electrodes and typical centro-parietal N400 effects over central electrodes. The distance effect appeared as an early-rising, long-lasting left parietal negativity. We suggest that ERP effects in the implicit task reflect access to semantic memory networks and to magnitude discrimination, respectively. In contrast, effects of expectation violation are more prominent in explicit tasks and may mask more delicate cognitive processes.This research was supported in part by a grant from the University of Padova to Giovanni Galfano and by the UK Medical Research Council grant G90951 (DS).This is the final version. It was first published by Elsevier at http://www.sciencedirect.com/science/article/pii/S030105111400218

Long-term monitoring of oxygen saturation at altitude can be useful in predicting the subsequent development of moderate to severe Acute Mountain Sickness

The use of pulse oximetry (SpO2) to identify subjects susceptible to AMS is the subject of debate. To obtain more reliable data, we monitored SpO2 for 24 hours at altitude to investigate the ability to predict impending AMS. Methods The study was conducted during the climb from Alagna (1154m) to Capanna Regina Margherita (4559m) with an overnight stay in Capanna Gnifetti (3647m). Sixty-two subjects (11F) were recruited. Each subject was fitted with a 24-hr recording finger pulse oximeter. The subjects rode a cable car to 3275m and climbed to 3647m, where they spent the night. Results In the morning, 24 (4F) had a Lake Louise Questionnaire score (LLS) ≥3 (AMS+), and 15 (4F) exhibited moderate to severe disease (LLS ≥5 = AMS++). At Alagna, SpO2 did not differ between the AMS- and AMS+. At higher stations, all AMS+ exhibited a significantly lower SpO2 than did the AMS-: at 3275m, 85.4% vs 87.7%; resting at 3647m, 84.5% vs 86.4%. The ROC curve analysis resulted in a rather poor discrimination between the AMS– and all of the AMS+. With the cut-off LLS ≥5, the sensitivity was 86.67%, the specificity was 82.5%, the AUC was 0.88 (p <0.0001) for SpO2≤84% at 3647m. Conclusions We conclude that AMS+ exhibit a more severe and prolonged oxygen desaturation than do AMS- starting from the beginning of altitude exposure, but the predictive power of SpO2 is accurate only for AMS++

Lesão intraepitelial de alto grau do colo uterino: relato de caso e revisão da literatura

Introdução: As lesões intraepiteliais de alto grau compreendem as displasias moderadas/grave, NIC II e NIC III e carcinoma in situ. O diagnóstico precoce das lesões através do rastreio pela colpocitologia oncótica (CCO) permite evitar/retardar a progressão para câncer invasor, utilizando-se de intervenções como colposcopia e biópsia, excisão local, conização e, eventualmente, histerectomia. Objetivo: Relatar caso de alteração na CCO, seguido de NIC II à biópsia. Metodologia: acompanhamento ambulatorial, cirirgia e revisão de prontuário. Resultados/Relato de Caso: S.S., feminino, 64 anos, encaminhada ao Conjunto Hospitalar de Sorocaba em novembro/2013 com resultado de ASC-h na CCO de maio/2013, e NIC II na biópsia de colo uterino de setembro/2013. Discussão e Conclusões: O vírus HPV é a principal etiopatogenia do câncer de colo de útero e de suas lesões precursoras, sendo os mais oncogênicos os subtipos 16 e 18, responsáveis por 70% dos casos. Todas as mulheres com laudo citopatológico de ASC-h devem realizar a colposcopia. Se presente alteração colposcópica, faz-se seguimento com biópsia. Se positiva para NIC II, deve ser realizada a Conização de Alta Frequência (CAF) ou Exérese da Zona de Transição (EZT)